An alternative guide to the new NHS in England

This content relates to the following topics:

Part of The King's Fund animationsThe NHS at 65

Article information

  • Posted:Monday 15 July 2013

This animation was created in 2013.  Please watch our updated version, How does the NHS in England work? An alternative guide, which was published in October 2017. 

In recent years, our health system has undergone profound change, with the 2012 Health and Social Care Act introducing the most wide-ranging reforms since the NHS was founded in 1948.

Watch and listen to our animation, which gives a whistle-stop tour of the NHS – how the organisations work and fit together – and explains that our system is as much a product of politics and circumstance as design.

This animation was created in 2013.

Updates as of April 2016

This animation was created in June 2013. Since then, there have been some changes to the way the system works:


The budget for the NHS in England in 2016/17 is £120.4 billion.

Nationally, NHS England commissions specialised services, primary care, offender healthcare and some services for the armed forces.

In April 2015, NHS England’s 13 local area teams were integrated into the four existing regional teams: London, Midlands and East, North and South, each maintaining a local presence.

In 2016/17, NHS England will transfer £71.9 billion to 209 clinical commissioning groups, responsible for commissioning a range of routine services (eg, urgent and emergency care services, elective hospital care, community health services, maternity and mental health services) for their local populations.

While NHS England initially commissioned general practice, CCGs are increasingly taking on responsibility for commissioning general practice in their area. In 2016/17 a total of 115 CCGs will have assumed full responsibility for the commissioning of primary medical care services under delegated commissioning arrangements. A further third will hold the responsibilities jointly with NHS England. Nearly all CCGs are expected to have taken on delegated arrangements by 2017/18.

Work is also ongoing to change the way in which specialised services are commissioned, including more collaborative commissioning between CCGs and NHS England.

Some CCGs are supported in their work by six (down from 19 when CCGs formally launched in April 2013) commissioning support units (CSUs) – although some also commission support from independent sector providers. Clinical senates and strategic clinical networks also provide expert clinical advice on issues that go beyond the remit of an individual CCG. There are also fifteen Academic Health Sciences Networks, intended to promote and encourage the adoption of innovation in health services. The remit of AHSNs is being considered as part of the Accelerated Access Review.

Local government

In 2016/17, there will be a mandatory minimum of £3.9 billion of pooled NHS funding to be spent jointly with local authorities as part of the Better Care Fund’s integration programme. Areas also have the flexibility to pool more than the mandatory amount.

From 1 October 2015 the responsibility for commissioning public health services for children aged 0-5 transferred from NHS England to local authorities. This marked the final part of the overall public health transfer which saw some wider public health functions (eg, services aimed at reducing drug and alcohol misuse) transfer to local government on 1 April 2013.


From 1 April 2016, leaders in Greater Manchester will start to have greater control over the region’s health and social care budget. This includes taking on delegated responsibility for several commissioning budgets currently controlled by NHS England, including for a number of specialised services and some public health services. These services will continue to be commissioned by NHS England, but decisions about service changes, finances, and quality and performance will be made through the newly appointed Chief Officer of Greater Manchester Health and Social Care, working with the 37 NHS organisations and local authorities in the region. Other areas are also pursuing ‘devolved’ arrangements.


From 1 April 2016, Monitor and the NHS Trust Development Authority will be brought together under a new umbrella organisation, NHS Improvement. The new body in charge of improvement in the NHS will also incorporate groups from three other organisations: NHS England’s Patient Safety Team and NHS Improving Quality’s Advancing Change Team; NHS Interim Management and Support’s two Intensive Support Teams; and the National Reporting and Learning System. NHS Improvement will oversee foundation trusts, NHS trusts and independent providers.

New models of care

The NHS five year forward view was published in October 2014, describing a range of changes, including new models of service delivery such as:

  • primary and acute care systems, to join up GP, hospital, community and mental health services
  • multi-specialty community service providers, to move specialist care out of hospitals into the community
  • enhanced health in care homes, to offer older people better, joined up health, care and rehabilitation services.

Since then, two further models have been introduced:

  • urgent and emergency care vanguards, to improve the coordination of services and reduce pressure on A&E departments, and
  • acute care collaborations, to link local hospitals together to improve their clinical and financial viability.

To implement these new care models, the NHS invited individual organisations and partnerships to apply to become ‘vanguards’ for the new care models programme; 50 vanguards have now been established across the country.

More about this animation

The inspiration for the animation was a session delivered to groups of clinicians as part of our leadership development programmes. Clinicians told us how useful the session was – whilst being experts in their own part of the health system, they were less clear about how the whole, complex system fits together. Our animation aims to bring the essence of this session to a wider audience – an introduction to the new NHS in 6.5 minutes. Find out more about our leadership development courses.


Andy Buttery

Specialist Trainer,
Trent Simulation & Clinical Skills
Comment date
09 July 2013
Bravo. Not cynical. When will politicians learn that re-organisation is not the answer to a (group of) QA problem(s)?

Kath Warren

Nurse Lecturer,
Sheffield Hallam University
Comment date
11 July 2013
Thank you, excellent animation. This will be really beneficial to establish the context of the NHS for Nursing Students,
Kind regards

James Courtney

Comment date
12 July 2013
A brilliant presentation that perfectly captures what a total disaster these reforms have been

Ruffat Ali-Noor

Governor NHS Berkshire,
As above
Comment date
13 July 2013
It is harsh fact that the complexity of this system is very difficult to explain but this excellent animation has done wonders, in such a short time the concept of NHS is given with great clarity.

Da Young

Comment date
16 July 2013
Thank you, what a great way of showing the new structure!
Could I please have JPEG images of the animation?

Kind Regards
Da Young

Mandy Davis

Leadership & OD,
Lancashire Teaching Hospitals NHS FT
Comment date
16 July 2013
Hi - I think this is a fantastic way of explaining a very complex system in an engaging way. I can see lots of ways in which we can utilise this presentation to help staff understand 'the bigger picture' too.

Which company did you use for the animation?

john m jack

music producer,
Cadillac Music & Publishing Ltd
Comment date
18 July 2013
The NHS has been the greatest addition to British society in the past hundred years; and a unique creation and
inspiration to the rest of the world. Both I and my beloved partner of some 34 years together owe our lives ,and subsequent current quality of health in our advancing years to the unstinted care the NHS has given us .
We are prepared to fight with any and all means at our disposal all attempts to destroy the service.
The NHS is Britain and assaults on it by politicians and their commercial masters should be seen as what they are TREASON.


Associate Director,
Strategic Clinical Networks
Comment date
19 July 2013
Great video, however, I think you have mixed up the Senates and the Strategic Clinical Networks. For the example given for advice around cardiac services, I would expect the CCG to talk to the Cardiovascular SCN not the Senate. The Senate is there for large strategic, complex change and difficult issues across the whole Senate footprint.


I am retired,
PPG member
Comment date
19 July 2013
An excellent animation, but sadly it just goes to prove that one set of complex structures is replaced by an even larger set of complex structures within the NHS (at great expense to the taxpayer)

Dora Kostiuk

Epilepsy Action
Comment date
21 July 2013
Hi Trevor,
I think that the animation helps to demonstrate how complex the hierarchy of the NHS is and makes it almost manageable.

Add your comment